Using CT guidance, a 19 guage needle was introduced on the left paralumbar approach and was directed toward the sac of abdominal aortic aneurysm.
The needle was advanced toward a type II endoleak with the guidance of a recent CT angiogram of the abdominal aorta dated 9/09/10. The needle was directed toward the maximum area of contrast enhancement within the sac near the lumbar branch.
The sac was punctured with the 19-guage needle. Retrograde blood flow to the needle confirmed the presence of the tip of the needle in the endoleak. Contrast was injected and an angiogram of the aneurysm sac and lumbar artery was performed using a C-arm.
At this point, DMSO was injected into the needle to prep the needle. This was followed by 3 mL of Onyx glue.
Extravasation of the glue was noted near the sac of the aneurysm. This is of no clinical significance. The patient tolerated the procedure well and no complications were encountered. A PCT angiogram in 30 days will be obtained.
Impression: Successful CT-guided and angiographic guided embolization of type II endoleak arising from a new lumbar branch. This is a de-novo branch feeding into the sac of the aneurysm.
Any suggestions for this would be greatly appreciated.